Failure of infection control in intensive care units: can sucralfate improve the situation?

Article Abstract:

Nosocomial, or hospital-acquired, infections are a significant cause of illness and death among hospitalized patients. At highest risk for life-threatening nosocomial infections are intensive care patients and those on mechanical ventilation. While nosocomial pneumonia is the hospital-acquired infection that poses the greatest threat to life, urinary tract infections and infections of surgical wounds cause significant illness. It is estimated that as many as 80 percent of patients in intensive care units might acquire some sort of nosocomial infection. In some studies, mortality among intensive care patients with pneumonia is as high as 50 percent. Many of the bacteria that are responsible for these infections are carried in the digestive tract of the patient. Much attention has been paid to the prevention of such infections, and many researchers now believe that using antibiotics to reduce the bacterial growth in the stomach may be more effective than providing prophylactic treatment to the lungs. This procedure has been termed ''selective digestive decontamination,'' or SDD. Significant reductions in not only pneumonia, but also in other types of nosocomial infections have been reported to result from SDD. However, many studies reporting these successes did not have control groups; they only compared results to findings on similar patients in the past. Nevertheless, confidence is high that SDD can be effective. Some patients are likely to develop stress ulcers if they are not given some sort of anti-ulcer treatment. Many anti-ulcer drugs reduce the secretion of stomach acid, thereby making the stomach a more favorable place for bacteria to grow. The anti-ulcer drug sucralfate helps protect against ulcers without decreasing the secretion of stomach acid, and thus would seem to be preferable for the treatment of hospitalized patients at risk for nosocomial infections. Research has established that, overall, SDD is better than sucralfate for the prevention of some infections. Ideally, patients who need ulcer treatment might be given both SDD and sucralfate. However, research has not yet investigated the effectiveness or possible side effects of simultaneously administering these two treatments. (Consumer Summary produced by Reliance Medical Information, Inc.)

Peptic ulcer, Sucralfate

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Epidemiology and control of nosocomial infections in adult intensive care units

Article Abstract:

Nosocomial infections, which are those acquired in the hospital, are five to 10 times more common in intensive care units (ICUs) than in general care hospital wards. The most common nosocomial infections in ICUs are respiratory infections, urinary tract infections, blood infections, and infections in surgical wounds. These types of infections can result from medical procedures or devices such as mechanical ventilators for breathing, urinary bladder catheters for removal of urine, catheters placed in veins for delivering medications or nutrients, internal devices used for monitoring the heart, and surgery. Gram-negative bacteria (Pseudomonas aeruginosa, Enterobacter species and Staphylococcus aureus) are the most common causes of infections in ICUs. These bacteria are normally present inside the body or on the skin. The use of medical procedures, devices or antibiotic drugs that favor the growth of these microorganisms can cause infections. To reduce the person-to-person spread of infection, medical staff should wash their hands frequently and wear gloves or gowns when working with infected patients. Patients with infections should be isolated and the area should be disinfected. When medical devices are the cause of the infection they should be removed, if possible. The most common reasons why attempts to control infections in ICUs fail include bacterial resistance to treatment with antibiotic drugs and the ability of microorganisms to be spread by hand contact, medical equipment, and from areas that harbor the growth of microorganisms, such as sinks and counter tops. A procedure called selective decontamination, which uses a solution or paste containing several different antibiotic drugs to decontaminate the mouth, throat and digestive tract of infected patients, has been used successfully in Europe. Although this method has been shown to reduce infections, it has not been approved for use in the United States. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Intensive care units

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Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit

Article Abstract:

Universal precautions have been increasingly instituted for workers in hospitals and other health care facilities. These procedures mandate that all hospital employees recognize all patients as potential carriers of transmissible infection. Thus, any health care worker who comes into contact with blood and body fluids must be prepared by wearing gloves. When the procedure is correctly followed, gloves should be changed between patients, and hands should be washed after glove removal. In the past, Acinetobacter calcoaceticus var. anitratus (A. anitratus), a pneumonia-causing bacteria that is often found in hospitals and is commonly resistant to antibiotics, has been known to be transmitted between patients by hand contact. Incorrect usage of gloves, especially with increased glove use, may be another likely source of transmission of the bacteria. This means of transmission was investigated during an outbreak of the infection in an intensive care unit (ICU). Five ICU patients developed pneumonia, one was asymptomatic; an emergency room patient also had the bacteria. The infection control staff found that gloves were not always changed between patients or between treatment of contaminated body areas. The bacteria was detected on an inhaler of an ICU patient with pneumonia and also on gloves used in caring for patients. Identical bacterial DNA was identified in two ICU patients with pneumonia, in the inhaler, in two asymptomatic patients, and on gloves, while different bacterial DNA were found in four other patient samples. When appropriate glove changing and hand-washing was reinforced, no further cases of infection were observed. The study emphasizes the importance of proper glove use in institutions where universal precautions are being observed to avoid an increase in many types of infections that can potentially be transmitted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Rubber gloves, Gloves (Surgery), Microbial contamination, Neisseriaceae

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